PEDIATRICS Vol. 86 No. 1 July 1990, pp. 87-90
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Elevated Liver Transaminase Levels in Children With Blunt Abdominal Trauma: A Predictor of Liver Injury

Halim M. Hennes MD1, Douglas S. Smith MD1, Kathleen Schneider MD1, Mary A. Hegenbarth MD1, Michael A. Duma MD1, and Juda Z. Jona MD1

1 From the Department of Pediatrics, Surgery, Trauma and Emergency Medicine, Medical Collage of Wisconsin, Milwaukee County Medical Complex, Children's Hospital of Wisconsin

The medical records of 43 hemodynamically stable children with elevated serum transaminase levels (aspartate aminotransferase [AST] and alanine aminotransferase [ALT]) who underwent abdominal computed tomographic (CT) scan for blunt abdominal trauma were reviewed. Nineteen patients (44.2%) had AST levels >450 IU/L and ALT levels >250 IU/L, and 17 of these 19 patients had hepatic injury identified on abdominal CT scan. Of the 43 patients, 25 (58.1%) had AST and ALT levels of less than 450 IU/L and 250 IU/L, respectively, and none of these patients had evidence of hepatic injury on CT scan. Elevated serum transaminase levels (AST >450 IU/L and ALT >250 IU/L) identified all of the patients with hepatic injury visible on abdominal CT scan. The sensitivity and specificity of elevated serum transaminase levels were 100% and 92.3%, respectively, for predicting hepatic injury. It is recommended that hemodynamically stable pediatric patients with blunt abdominal trauma and AST levels >450 IU/L and/or ALT levels >250 IU/L undergo abdominal CT scan to determine the presence and extent of hepatic injury. Children with serum transaminase levels below these values are at decreased risk of liver injury.

Key Words: serum transaminase • liver injury • blunt abdominal injury • abdominal computed tomographic scan

Submitted on July 5, 1989
Accepted on August 15, 1989




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